A Quick Guide to North Carolina Health Insurance in 2017

Wondering what 2017 health insurance plans cover in North Carolina? Want a better picture of what North Carolina Health insurance looks like in 2017? We put together this quick guide for those looking to enroll or make changes to their 2017 health insurance, so that they can understand what to expect.

Comparing North Carolina Health Insurance Plans:There are five different factors to look at when comparing 2017 NC health insurance plans:

  1. The Category
  2. The Benefits
  3. The Premium
  4. The Out-of-Pocket Expenses
  5. The Provider Network

The Category: There are five different categories of health insurance plans offered on the Health Insurance Marketplace: Bronze, Silver, Gold, Platinum and Catastrophic. These categories are defined strictly based on the percentage you pay on average for your healthcare expenses versus the percentage the insurance carrier pays. For example, Bronze level plans only pay for an average of 60% of covered medical expenses (and you pay 40%), while Gold level plans pay for an average of 90% of covered medical expenses (and you pay 10%). The more a plan requires your insurance carrier to pay in the event medical care is required, the higher your premiums will be.

The Benefits: All 2017 North Carolina health insurance plans must cover the same 10 minimum essential benefits, regardless of the cost of the plan. However, some plans with higher premiums may offer additional benefits beyond minimum requirements.

The Premium: A premium is the up-front cost you pay to the insurance company on a monthly basis for providing you coverage. Low premiums may seem attractive, but be sure to take a look at the accompanying deductibles, coinsurance payments and out-of-pocket maximums tied to each premium. Plans with the lowest premiums often have the highest out-of-pocket expenses. In some cases, low premium plans may require that a high deductible be met before coverage benefits kick in. For this reason, those who find themselves requiring routine medical care may wish to consider paying a higher premium in exchange for lower out-of-pocket expenses.

The Out-of-Pocket Expenses: Out-of-pocket expenses are exactly as they sound – the amount you must pay out of pocket for your medical care, in addition to your premium. Out-of-pocket expenses associated with health insurance plans include: deductibles, copayments, coinsurance and prescription drug cost. Be sure to look at these closely when selecting your 2017 North Carolina health insurance plan, as you will be expected to pay these expenses, in addition to your premium, should you require medical care. You can learn more about each of these expenses and what they mean in our glossary of health insurance terms. All health plans have a limit on out of pocket expenses, commonly referred to as the “out of pocket maximum”. After you satisfy the “out of pocket maximum”, you will have no more out of pocket costs for covered medical benefits for the remainder of the benefit (calendar) year.

The Provider Network: Be sure to take a look at the insurance carrier’s provider network to ensure your existing doctor is listed as an in-network provider. If you travel quite a bit, look to see if the plan has in-network providers in the areas you travel to, in addition to where you live. If you use a provider that is in-network, you will pay lower rates than if you use an out-of-network physician.